Cataract surgery in eyes with keratoconus: a review of the current literature

There are an increasing number of keratoconic eyes, requiring cataract surgery. We review the preoperative planning, intraoperative options, and postoperative management that aid in successful outcomes.

Management of keratoconic eyes requiring cataract surgery requires a multifaceted approach. Preoperatively, corneal crosslinking and intrastromal corneal ring segments can be considered in order to provide stable keratometry values for intraocular lens (IOL) calculations. Deciding between toric and monofocal IOLs requires a thorough evaluation. Intraoperatively, the decision of clear corneal incisions with or without sutures versus scleral incisions is important to mitigate postoperative complications. Postoperatively, irregular astigmatism should be evaluated and updated rigid gas permeable or scleral lenses provided. Patients needing irregular astigmatism correction postoperatively should not have toric IOL implantation; however, in select cases of keratoconus, it is an option.

The use of stabilizing procedures prior to optical biometry can aid in preoperative lens selection and provide predictable surgical outcomes. Decisions on intraoperative wound construction and toric versus monofocal lenses should be based on the severity, regularity, and central nature of the keratoconus. Postoperative use of rigid gas permeable or scleral lenses can help patients achieve their best visual potential.